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Donate, or don’t ask

Donate, or don’t ask

New Zealand has one of the lowest organ donor rates in the Western World.

Despite three years of pleading, lobbying and Parliamentary Select Committee hearings last year the number organ donors was just 40 people.

The three years haven’t been wasted though. After a lot of red tape, wrangling and arguing there are some changes in the pipeline, even though some of them are un-enthusiastic token efforts on behalf of the Government and Health Ministry.

It is noted in some other countries that the Minister of Health is very vocal and enthusiastic on organ donation reform. Here in New Zealand the Minister of Health sits on the fence and won’t commit to anything until the endless supply of bureaucrats tell her what to say. It is a classic case of ‘the tail wagging the dog. Whilst the forthcoming changes in practices will no doubt see a small rise in the number of organ donors it will never be enough to meet demand, meaning that thousands of people will die unnecessarily, buried next to people who had the power to save those lives, but for reasons known only to themselves chose to donate them to the maggots instead. They may have been willing to be organ donors but did not realise that it’s not their choice anyway, it’s their families’ choice; whoever the definition of family is these days… It may be that they were one of the 40% of potential donors that their relatives vetoed a request for the ‘gift of life.’ In New Zealand autonomy dies with the patient…

During my research, I came across an ‘innovative healthcare solution’ which could not only improve the donor rate, but in time wipe out the waiting list for organ transplants.

A non-profit group in the US, called Lifesharers aims to do just that by circumventing the red tape of government and running their own ‘organ donor club. It’s simple, it’s fair anyone can join for free and it’s effective.

Their premise is that if you are not prepared to be a donor then you should go below people on the waiting lists who are registered donors. This causes more people to sign up as donors and even benefits those who refuse to donate, but are happy to receive.

It is a system I am following closely and am in touch with my American counterparts to consider implementing such a system here.

It is estimated that approximately 70% of today’s transplanted organs go to recipients who are not prepared to be donors themselves, while many of those who are willing to be donors go without. Justice would connect the business of organ procurement with the matter of organ distribution. Access to organs for transplantation should be linked to the willingness to be an organ donor. The right to receive a donated organ should be tied to the duty to offer to donate organs.

As in socialism in general, in organ socialism the criterion is need and not contribution thereby wiping out incentives to contribute. Many of those who would not donate organs would still accept an organ if they needed one. These people are willing to benefit from a common resource without investing anything to create it.

A problem with the current system by which donor organs are rationed is that it takes no account of, indeed it encourages, the 'free rider': the individual who hopes to benefit from the cooperation of others even though he does not himself contribute to the socially desired end. Although it is in each individual’s interest that donor organs should be available, it is in nobody’s interests to make his/her own organs available.

On Monday, Jack can express his religious or aesthetic opposition to organ donation, and on Tuesday, perhaps after being diagnosed with life-threatening liver failure, immediately enter a waiting list for a new liver. Julie, on the other hand, may have expressed a lifelong willingness to donate, may have encouraged her family and friends to declare their intentions to donate, and, under the current system, will enter the waiting list under the same terms and with the same waiting time as Jack. If we are skittish at all about giving Julie preference over Jack, we must remember that the entire system of organ donation depends on the goodwill of organ donors. In a world of Jacks, there would be no organ donation at all.

Our current system relies solely on altruism to motivate donation. Altruism is a fine thing but it is in short supply. Relying purely on altruism for organ donations would certainly be ideal, but it is not worth the loss of many lives annually. We may hope for love but should plan on self-interest for the sake of ourselves and our children. This new system would replace a system based on handouts with one based on individual responsibility...

People are motivated more by self-interest than by altruism. To increase organ donation, the incentive needs to be aligned with self-interests. Agreeing to 'give the gift of life' would no longer be an act of pure altruism; rather it would be an insurance policy. Even the most selfish of individuals would be willing to become donors if it gave them greater access to the hearts or livers that might save their lives.

Those who want to give priority to those who were and still are willing to donate need not want to exclude other people from organs. All that is needed is an interest in furthering and rewarding morally fair contributions to practices that lie in the interest of all. People may feel compassion with those who do not contribute as well as with those who do contribute but still may feel the need to give priority to those who are contributors if a choice must be made due to scarcity. And this is an ethically entirely respectable motive.”

The benefits of registering under a priority incentive program clearly exceed the costs. Even after registering, it is extremely unlikely that a registrant will donate organs because it is rare to die with organs medically eligible for transplantation. Potential donors can make the trade off between the very remote possibility of becoming an organ donor and the not-quite-so remote possibility of needing an organ.

Opponents of the scheme may say it’s not fair. In fact, it makes the organ allocation system fairer. What isn’t fair is giving an organ to someone who won’t donate their own, when there is a registered organ donor who needs it. It’s like awarding the lotto jackpot to someone who didn’t buy a ticket.

When you die, you can bury your organs, cremate them, or donate them and save lives. When those are your only choices, deciding not to donate is a spectacularly selfish thing to do. People who make that decision have no moral claim to an organ transplant. Without organ donors there can be no organ transplants.

Opponents may also claim that it is a slippery slope. They are wrong. Giving organs first to women doesn't produce more women, and giving organs first to Christians doesn't produce more Christians. But giving organs first to organ donors produces more organ donors, and that saves lives. The goal of our organ donation system should be to save lives, not to spread deaths equally among groups.

As long as people who refuse to be a donor can jump to the front of the waiting list if they need a transplant we'll always have an organ shortage. The solution to the organ shortage is simple -- if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live.

Andy Tookey is promoter of GiveLife NZ an organ donation reform lobby group More details on


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